Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 5, 2021
Date Accepted: Feb 18, 2022
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Exercise, Educational and Self-Management Program Delivered with the CareHand Smartphone App in Adults with Rheumatoid Arthritis of the Hands: A Randomized Controlled Trial
ABSTRACT
Background:
Rheumatoid Arthritis (RA) is a highly prevalent autoimmune disease that usually involves hand or wrist problems. Current evidence suggests a multimodal therapy for RA including exercise, self-management, and educational strategies. To date, the efficacy of this approach as delivered with a smartphone app has been scarcely investigated.
Objective:
To assess the short and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with a conventional approach, for adults with RA of the hands.
Methods:
A single-blinded randomized controlled trial was conducted including individuals with hands RA. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, combined with self-management and monitoring tools; or to a Control group that received a written home exercise routine and recommendations on a paper sheet, as the usual protocol provided at primary care settings. Both interventions lasted for three months (4 times a week). The primary outcome was hand function, assessed with the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (Visual Analogue Scale, VAS), grip (dynamometer) and pinch strength (pinch gauge), and upper limb function (Quick DASH). All measures were collected at baseline and at a 3-month follow-up. Further, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain and Quick DASH were also collected at 1- and 6-months follow-up.
Results:
A total of 36 adults (60.22 ± 9.66 years, 61.11% women) were recruited, from which 30 individuals, corresponding to 58 hands (CareHand group=26, Control group=32) were included in the analysis. Around 55% of them were under disease-modifying antirheumatic drugs treatment at baseline. The ANOVA demonstrated a significant time*group effect for the total score of the MHQ (F=9.163, P<.001, η2=0.147), and for several of its subscales: hand overall function, work performance, pain, and satisfaction (all, P<.05), with mean differences between groups for the total score of 16.86 points (95% CI 8.70 to 25.03) at 3 months, and 17.21 points (95% CI 4.78 to 29.63) at 6 months. Further, no time*group interaction was observed for any of the secondary measures (all P>.05).
Conclusions:
Adults with RA of the hands that used the digital app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared to usual care. The current findings suggest that the CareHand app is a promising digital tool for delivering exercise therapy and self-management recommendations in this population. Clinical Trial: NCT04263974 clinicaltrials.gov.
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